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INTRODUCTION: Cerebral Venous Sinus Thrombosis (CVST) primarily affects children and young adults, especially young women of child-bearing age. Despite overall favorable outcome with systemic anticoagulation, it is still associated with up to 15% mortality and a high incidence of morbidity, resulting in a significant loss of productive life. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) are inflammatory and immunologic serum biomarkers that have been described to be predictive of outcome in arterial and venous thromboembolism events including pulmonary embolism and ischemic stroke. Nonetheless, predictive values of these ratios in CVST are not well established. METHODS: This is a single-center, observational and retrospective study that included patients diagnosed with CVST from January 2004 to December 2016 in University of Iowa Hospitals and Clinics. Patients with age older than 18 years were included. Exclusion criteria were incomplete clinical or laboratory data and patients with active malignancy receiving chemotherapy at the time of CVST diagnosis. Patients' complete blood count obtained at admission was used for ratio calculation. Receiver Operating Characteristic (ROC) curve was used to determine cutoff value for the ratios. Predictive utility of each ratio was evaluated in separate multivariate logistic regression models, conditioned on variables that were already shown to have strong association with mRS outcome in univariate analyses. An Akaike information criterion (AIC)-based backward stepwise selection scheme was used for model selection. Functional outcome was assessed by using modified Rankin score (mRS) which was into good outcome (mRS score of 0 to 2) and poor outcome (mRS score of 3 to 6). A two-sided p-value of 0.05 was considered statistically significant. RESULTS: 134 patients were included; median age was 42 years (IQR = 26.75 years) and 90 (67%) were female. The overall mortality was 9% (N=13). After adjusting by demographic characteristics, presenting symptoms and comorbidities, NLR>6.24 (OR=4.57, 95% CI 1.85 - 11.29, p=0.001) and PLR>144 (OR=4.80, 95% CI 1.95 - 11.82, p=0.001) were statistically associated with poor mRS (mRS 3-6) at hospital discharge. Altered mental status on presentation was independently correlated with poor neurologic outcome and in-hospital mortality. While altered motor function and concomitant infection correlated with higher mRS and higher mortality, respectively. The present study did not observe significant prediction between ratios and in-hospital mortality, being NLR marginally significant (OR= 4.67, 95% CI 0.85 - 25.67, p=0.077). CONCLUSION: To the best of our knowledge, this is the first study that describes a statistically significant association between increased NLR and PLR at admission and poor functional outcome in CVST patients at discharge. Their predictive value could be potentially used in the early identification of high-risk patients who may benefit from more aggressive therapeutic approaches, such as endovascular treatment. Disclosures No relevant conflicts of interest to declare.

Background: Current risk stratification for patients with acute promyelocytic leukemia (APL) is based solely on the presenting white blood cell count. There are conflicting data concerning the prognostic relevance of additional cytogenetic abnormalities (ACA) beyond t(15;17) and whether the presence of such abnormalities might influence treatment decisions for patients with APL. This is especially unclear among patients receiving ATO given that many existing data are from patients treated prior to incorporation of ATO into treatment paradigms. We sought to determine the prognostic importance of ACA and complex karyotype (CK) in influencing event-free survival in patients with APL. Methods: We analyzed patients with APL evaluated at our center since 2005 and patients treated in the Australasian Leukaemia and Lymphoma Group APML4 study (frontline ATRA + ATO + idarubicin,Lancet Haematology2015). We included all patients with baseline karyotype and those without karyotype but with FISH at diagnosis revealing ACA. Chart review extracted patient, disease, and clinical data. Only patients who commenced induction therapy with an ATO-based regimen were included in this analysis to ensure uniformity of the study population and applicability of results to contemporary clinical practice in APL. We also included patients deceased early in the disease course (1 ACA beyond t(15;17). Coagulopathy was defined as either APTT/mean laboratory normal APTT >1.5, INR >1.5 (PT/mean laboratory normal PT >1.5 when INR and ISI unavailable), or fibrinogen Results: A total of 168 patients were included (N = 49 MSKCC, 109 APML4); 6 patients were removed from the MSKCC cohort due to relapse prior to initial visit and one from APML4 due to lack of follow-up information (Table 1). The mean age at diagnosis was 47 years in the MSKCC cohort and 43 years in the APML4. Median follow-up among survivors was 36 months (MSKCC, range 2-144) and 54 months (APML4, range 28-96); overall survival is displayed in Figure 1. Forty-nine (31%) patients' disease harbored ACA (most commonly trisomy 8 in 25 patients), and 17 CK (12% MSKCC, 10% APML4, denominator excludes one patient with single ACA by FISH). The event-free survival did not differ between ACA+ and ACA- (Table 2), but patients with +CK harbored inferior EFS (9/139 events non-CK vs. 4/17 events CK). No other clinical parameters that we queried correlated with EFS. Conclusions: In a large cohort pooled from a single-center experience and a cooperative prospective trial, the presence of an ACA beyond t(15;17) did not influence EFS in patients with APL. However, our data suggested that CK influences EFS. Further studies could collect data from other cooperative trials and/or single institutions to garner adequate power to better address the question of CK influencing EFS and confirm these preliminary findings. If a convincing signal emerges, treatment paradigms could be altered in the context of a prospective study (for example, intensifying or prolonging treatment) towards overcoming this adverse effect. Disclosures Park: Minverva:Consultancy;Kite:Consultancy, Research Funding;Amgen:Consultancy, Research Funding;Intellia:Consultancy;Artiva:Membership on an entity's Board of Directors or advisory committees;AstraZeneca:Consultancy;Incyte:Consultancy, Research Funding;GSK:Consultancy;Juno Therapeutics:Research Funding;Autolus:Consultancy, Research Funding;Genentech/Roche:Research Funding;Fate Therapeutics:Research Funding;Servier:Consultancy, Research Funding;Takeda:Consultancy, Research Funding;Novartis:Consultancy;Allogene:Consultancy.Stein:Biotheryx:Consultancy;Bayer:Research Funding;Genentech:Consultancy, Membership on an entity's Board of Directors or advisory committees;Syndax:Consultancy, Research Funding;Seattle Genetics:Consultancy;Abbvie:Consultancy;Amgen:Consultancy;Celgene Pharmaceuticals:Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Agios Pharmaceuticals:Consultancy, Membership on an entity's Board of Directors or advisory committees;Astellas Pharmaceuticals:Consultancy, Membership on an entity's Board of Directors or advisory committees;Novartis:Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;PTC Therapeutics:Membership on an entity's Board of Directors or advisory committees;Syros:Membership on an entity's Board of Directors or advisory committees;Daiichi-Sankyo:Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding.Tallman:Bioline rx:Membership on an entity's Board of Directors or advisory committees;Amgen:Research Funding;Rafael:Research Funding;Orsenix:Research Funding;ADC Therapeutics:Research Funding;BioSight:Membership on an entity's Board of Directors or advisory committees, Research Funding;Glycomimetics:Research Funding;Novartis:Membership on an entity's Board of Directors or advisory committees;Roche:Membership on an entity's Board of Directors or advisory committees;UpToDate:Patents & Royalties;KAHR:Membership on an entity's Board of Directors or advisory committees;Rigel:Membership on an entity's Board of Directors or advisory committees;Delta Fly Pharma:Membership on an entity's Board of Directors or advisory committees;Oncolyze:Membership on an entity's Board of Directors or advisory committees;Jazz Pharma:Membership on an entity's Board of Directors or advisory committees;Daiichi-Sankyo:Membership on an entity's Board of Directors or advisory committees;Cellerant:Research Funding;Abbvie:Research Funding.

Bronchial-associated lymphoid tissue lymphoma (BALT) is a rare subtype of extranodal marginal zone lymphoma that is often diagnosed incidentally, without symptoms or compromise of pulmonary function. It usually progresses slowly . However, in contrast to other subtypes, oncologists may feel compelled to initiate treatment at the time of diagnosis, because of concern for progression resulting in irreversible lung damage. It is unclear, in many cases, whether the morbidity of treatment would be greater than that of the lymphoma itself. To address this issue, we compared patients with BALT initially managed expectantly to those receiving front-line treatment. A retrospective single institutional review of newly diagnosed primary BALT treated at Memorial Sloan Kettering Cancer Center between 1995 and 2017 was performed. Patients with evidence of extra-thoracic disease (except for isolated bone marrow involvement) and those with concurrent malignancy were excluded. Expectant management (active surveillance) was defined as a management plan of observation rather than treatment at diagnosis and at least 3 months of follow-up from completion of all diagnostic workup until initiation of subsequent therapy if necessary. Surgical Resection referred to complete resection of all disease lesions for diagnosis. Overall (OS) and event-free survival (EFS) were determined from diagnosis as time to treatment or death of any cause, among patients with surgical resection, active surveillance, and time-to-next treatment among those treated at diagnosis with systemic immuno/chemo-immunotherapy (systemic treatment). Medical records of 200 consecutive patients with MZL involving the lung were reviewed, and 127 met the criteria for primary BALT. Of the remaining 73 patients, 25 had concurrent malignancy and 48 had extra-thoracic disease. Nearly half (48%; n=61) had initial active surveillance, 40% (n=51) surgical resection, and 12% (n=15) systemic treatment at diagnosis. Median age was 65 years (IQR 54-74). Females predominated (64%, n=81). Rates of current or prior smoking (61%; n=78) and of autoimmune/connective tissue disease (20%; n=26) were high. Nearly half of the cases with concurrent cancers were primary carcinomas of the lung (n=11). Most patients presented with a single lesion (76%; n=96) with median size 2.5 cm (IQR 1.6-3.6) and without lobar predominance. A minority (5.5%; n=7) presented with thoracic nodal involvement, while 25% (n=32) presented with pleural involvement or effusion. Overall, few patients had bone marrow involvement, B symptoms, cytopenia or elevated LDH. With a median follow-up of over 60 months (IQR 25 - 107), estimated 6-year OS for the entire cohort was 92% (0.86, 0.98). Notably, high survival rates were found in all 3 groups (Figure 1). Estimated 6-year survivals were 88% (0.77,1.00) for patients with disease remaining after biopsy managed by active surveillance, 100% with initial complete diagnostic excision (surgical resection) and 78% (0.59, 1.00) for those with initial systemic treatment who likely had extensive initial disease and/or symptoms. Active surveillance patients had a shorter EFS than surgical resection patients but not than systemic treatment patients (6yEFS 63% vs. 74% vs. 57%, respectively; p=0.006). Estimated 6-year EFS (survival without treatment) of patients initially managed by active surveillance was 63% (95% CI 0.5-0.8), and 12% required only a single line of therapy (6yEFS2 85%; 95% CI 0.7-1.0). In conclusion, BALT is an indolent disease in most patients that can be managed expectantly and may not require therapy for many years. Slightly better survival in patients with fully resected disease could represent a selection bias of earlier detection or biologically less active disease. Initial observation of the pace of the disease in asymptomatic patients may clarify the minority who require treatment and avoid or delay its potential risks in the majority. Figure 1 Disclosures Rajeeve: ASH-HONORS Grant: Research Funding. Zelenetz:Verastem: Consultancy, Membership on an entity's Board of Directors or advisory committees; DAVA Oncology: Consultancy, Membership on an entity's Board of Directors or advisory committees; DAVA Oncology: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Morphosys: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pharmacyclics/AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Verastem: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bayer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Astra-Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bayer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Beigene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Beigene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees; Karyopharm: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech/Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees; Genentech/Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pharmacyclics/AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; MEI Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; MEI Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Astra-Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees; Karyopharm: Consultancy, Membership on an entity's Board of Directors or advisory committees; Morphosys: Consultancy, Membership on an entity's Board of Directors or advisory committees. Palomba:STRAXIMM: Membership on an entity's Board of Directors or advisory committees; Evelo: Equity Ownership; Kite Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Seres Therapeutics: Equity Ownership; Noble Insights: Consultancy; Merck & Co Inc.: Consultancy; MSK (IP for Juno and Seres): Patents & Royalties; Hemedicus: Speakers Bureau; Pharmacyclics: Membership on an entity's Board of Directors or advisory committees. Moskowitz:Pharmacyclics: Research Funding; Seattle Genetics, Inc.: Consultancy, Research Funding; Merck: Consultancy, Research Funding; ADC Therapeutics: Research Funding; Celgene: Consultancy; Genentech: Consultancy, Research Funding. Noy:Medscape: Honoraria; Prime Oncology: Honoraria; NIH: Research Funding; Janssen: Consultancy; Pharamcyclics: Research Funding; Raphael Pharma: Research Funding. Horwitz:Mundipharma: Consultancy; Celgene: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Innate Pharma: Consultancy; Portola: Consultancy; Celgene: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Affimed: Consultancy; Affimed: Consultancy; Kyowa Hakko Kirin: Consultancy; Millennium/Takeda: Consultancy, Research Funding; Millennium/Takeda: Consultancy, Research Funding; Infinity/Verastem: Consultancy, Research Funding; Kura: Consultancy; Forty-Seven: Research Funding; Trillium: Research Funding; Mundipharma: Consultancy; Affimed: Consultancy; Kyowa Hakko Kirin: Consultancy; ADCT Therapeutics: Research Funding; Miragen: Consultancy; Trillium: Research Funding; Forty-Seven: Research Funding; Infinity/Verastem: Consultancy, Research Funding; Astex: Consultancy; Portola: Consultancy; Mundipharma: Consultancy; Mundipharma: Consultancy; Corvus Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Corvus Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Astex: Consultancy; Kyowa Hakko Kirin: Consultancy; Seattle Genetics: Consultancy, Research Funding; ADCT Therapeutics: Research Funding; Millennium/Takeda: Consultancy, Research Funding; Astex: Consultancy; Portola: Consultancy; Kura: Consultancy; Innate Pharma: Consultancy; Kura: Consultancy; Miragen: Consultancy; Seattle Genetics: Consultancy, Research Funding; Aileron: Research Funding; ADCT Therapeutics: Research Funding; ADCT Therapeutics: Research Funding; Infinity/Verastem: Consultancy, Research Funding; Corvus Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kyowa Hakko Kirin: Consultancy; Miragen: Consultancy; Portola: Consultancy; Trillium: Research Funding; Seattle Genetics: Consultancy, Research Funding; Aileron: Research Funding; Forty-Seven: Research Funding; Aileron: Research Funding; Kura: Consultancy; Aileron: Research Funding; Miragen: Consultancy; Corvus Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Affimed: Consultancy; Innate Pharma: Consultancy; Astex: Consultancy; Forty-Seven: Research Funding; Innate Pharma: Consultancy; Millennium/Takeda: Consultancy, Research Funding; Infinity/Verastem: Consultancy, Research Funding; Trillium: Research Funding. Moskowitz:Incyte: Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Incyte: Research Funding; Merck: Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Incyte: Research Funding; Incyte: Research Funding; Cell Medica: Consultancy; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Merck: Research Funding; Merck: Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Merck: Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Incyte: Research Funding; Cell Medica: Consultancy; Cell Medica: Consultancy; miRagen Therapeutics Inc: Consultancy, Research Funding; Erytech Pharma: Consultancy; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Cell Medica: Consultancy; Merck: Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Erytech Pharma: Consultancy; Merck: Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Takeda Pharmaceuticals: Consultancy; Merck: Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Merck: Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Merck: Research Funding; Merck: Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Merck: Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Merck: Research Funding; Merck: Research Funding; Erytech Pharma: Consultancy; ADC Therapeutics: Consultancy; Seattle Genetics: Consultancy, Honoraria, Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; Incyte: Research Funding; Takeda Pharmaceuticals: Consultancy; Incyte: Research Funding; Cell Medica: Consultancy; Incyte: Research Funding; Cell Medica: Consultancy; miRagen Therapeutics Inc: Consultancy, Research Funding; Incyte: Research Funding; Cell Medica: Consultancy; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Erytech Pharma: Consultancy; Incyte: Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Erytech Pharma: Consultancy; Erytech Pharma: Consultancy; ADC Therapeutics: Consultancy; ADC Therapeutics: Consultancy; ADC Therapeutics: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Cell Medica: Consultancy; ADC Therapeutics: Consultancy; ADC Therapeutics: Consultancy; Incyte: Research Funding; Incyte: Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Erytech Pharma: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Incyte: Research Funding; ADC Therapeutics: Consultancy; ADC Therapeutics: Consultancy; Erytech Pharma: Consultancy; Erytech Pharma: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; Erytech Pharma: Consultancy; Erytech Pharma: Consultancy; ADC Therapeutics: Consultancy; Cell Medica: Consultancy; miRagen Therapeutics Inc: Consultancy, Research Funding; Merck: Research Funding; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; ADC Therapeutics: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; Erytech Pharma: Consultancy; ADC Therapeutics: Consultancy; miRagen Therapeutics Inc: Consultancy, Research Funding; Takeda Pharmaceuticals: Consultancy; Takeda Pharmaceuticals: Consultancy; Cell Medica: Consultancy; ADC Therapeutics: Consultancy; ADC Therapeutics: Consultancy; miRagen Therapeutics Inc: Consultancy, Research Funding; Incyte: Research Funding; miRagen Therapeutics Inc: Consultancy, Research Funding; Takeda Pharmaceuticals: Consultancy; Incyte: Research Funding; Takeda Pharmaceuticals: Consultancy; Cell Medica: Consultancy; Cell Medica: Consultancy; Takeda Pharmaceuticals: Consultancy; Takeda Pharmaceuticals: Consultancy; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Erytech Pharma: Consultancy; Takeda Pharmaceuticals: Consultancy; Kyowa Hakko Kirin Pharma: Consultancy, Research Funding; Cell Medica: Consultancy; Cell Medica: Consultancy; Cell Medica: Consultancy; Takeda Pharmaceuticals: Consultancy; Seattle Genetics: Consultancy, Honoraria, Research Funding; ADC Therapeutics: Consultancy; ADC Therapeutics: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; Takeda Pharmaceuticals: Consultancy; Takeda Pharmaceuticals: Consultancy; miRagen Therapeutics Inc: Consultancy, Research Funding; Takeda Pharmaceuticals: Consultancy; Takeda Pharmaceuticals: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; Merck: Research Funding; Erytech Pharma: Consultancy; Erytech Pharma: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; Takeda Pharmaceuticals: Consultancy; Bristol-Myers Squibb: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding. Matasar:GlaxoSmithKline: Honoraria, Research Funding; Teva: Consultancy; Juno Therapeutics: Consultancy; Merck: Consultancy, Equity Ownership; Roche: Consultancy, Honoraria, Other: Travel, accommodation, expenses , Research Funding; Genentech, Inc.: Consultancy, Honoraria, Other: Travel, accommodation, expenses , Research Funding; Bayer: Consultancy, Honoraria, Other; Daiichi Sankyo: Consultancy; Seattle Genetics: Consultancy, Honoraria, Other: Travel, accomodation, expenses, Research Funding; Rocket Medical: Consultancy, Research Funding; Bayer: Other: Travel, accommodation, expenses; Janssen: Honoraria, Research Funding; Pharmacyclics: Consultancy, Honoraria, Research Funding. Kumar:Seattle Genetics: Research Funding. von Keudell:Bayer: Consultancy; Bayer: Consultancy; Pharmacyclics: Consultancy; Pharmacyclics: Consultancy; Genentech: Consultancy; Genentech: Consultancy. Batlevi:Juno Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees. Younes:Syndax: Research Funding; BMS: Research Funding; Celgene: Consultancy, Honoraria; AstraZeneca: Research Funding; Pharmacyclics: Research Funding; Takeda: Honoraria; Abbvie: Honoraria; HCM: Consultancy; Biopath: Consultancy; Xynomics: Consultancy; Epizyme: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Research Funding; Merck: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Curis: Honoraria, Research Funding; Genentech: Research Funding. Straus:Seattle Genetics: Consultancy, Honoraria; Elsevier (PracticeUpdate): Consultancy, Honoraria; Hope Funds for Cancer Research: Membership on an entity's Board of Directors or advisory committees.

Introduction: Early readmissions are important indicators of quality of health-care. National-level data is currently lacking for patients admitted for induction chemotherapy for acute myeloid leukemia (AML). Our study is to investigate characteristics and predictors of 30-day hospital readmission in patients with AML after receiving induction chemotherapy. Methods: We analyzed the 2016 United States National Readmission Database, the latest and largest readmission database available so far. The authors identified hospitalizations for patients using ICD-10 codes for "encounter for chemotherapy" or a procedure code for administration of antineoplastic agent as the primary diagnosis with a secondary diagnosis of acute myeloid leukemia or myeloid sarcoma. We excluded patients who had a personal history of chemotherapy or those in remission or relapse in order to avoid counting patients admitted for consolidation/ re-induction chemotherapy. A readmission was defined as the first admission to any hospital for any non-traumatic diagnosis within 30 days of discharge after the index admission. Same day admissions and discharges were excluded. The primary outcome was 30-day readmission rate. Secondary outcomes were 30-day mortality rate, most common reasons for readmission, readmission mortality rate and resource utilization (length of stay and hospitalization costs). Independent risk factors for readmission were identified using multivariate regression analysis. Results: A total of 18,140 admissions were identified for induction chemotherapy. The median age was 64.1 years and 45% of patients were female. The all cause 30-day readmission rates were 30.1%. The in-hospital and 30-day mortality rate were 3.9% and 4.8%, respectively. The in-hospital mortality rate for readmitted patients was 3.8%. The top five causes for unplanned readmissions were neutropenia (7.2%), sepsis (6.1%), pneumonia (2.6%), acute kidney injury (2.5%) and neoplasm related pain (2.3%). Mean total charges were higher during index admission than readmission ($118,449 vs $49,087, p=.000). Table 1 shows the base patient characteristics and Table 2 shows the odds ratios of the various factors tested as independent predictors of readmission. Independent predictors of readmission were younger age, low income, Medicaid, uninsured or Private Insurance, co-morbidities, urban hospital and length of stay during index hospitalization. The total hospital days associated with readmission were 102,924 days, with a total healthcare economic burden of $303 million. Conclusions: Our study reveals that there is a significant readmission rate in this study population generating a substantial financial burden. 30-day readmissions are primarily due to neutropenia and infectious etiologies including sepsis and pneumonia. This emphasizes the urgent need for organizing better outpatient follow up for these patients post-hospitalization as well as increased awareness for antibiotic prophylaxis. Further research into development of clinical models for risk stratification is also required. Disclosures Rajeeve: ASH-HONORS Grant: Research Funding.

Background: Myelodysplastic syndromes (MDS) most commonly occur in the elderly and are associated with bone marrow failure and potential transformation to acute myeloid leukemia. With the proportion of elderly population being on the rise in the US, conditions like MDS are likely to generate significant burden on the healthcare system. Our study is the first report aimed to analyze trends in mortality, costs of hospitalization, length of stay (LOS) and the rate of complications in patients with MDS over the past decade. Methods: We queried the Nationwide Inpatient Sample (NIS) database to obtain data on patients hospitalized with MDS between 2005-2014. The ICD-9 codes 238.72, 238.73, 238.74 and 238.75 were applied in the primary diagnosis field. Patient characteristics including age, sex, insurance and hospital characteristics such as location, teaching status were recorded. Data regarding mortality, LOS and total hospitalization charges was examined and the trend was analyzed over the 10 year interval. We also determined the incidence of common in-hospital complications, and comparisons were made between academic and non-academic institutions. Results: Over the 10-year interval, a total of 885,726 admissions were identified, out of which 803,341 admissions (90.6%) were in patients aged >65 years. The mean age of the population was 76.19 years and 47.6% patients were females. Majority of patients were treated at non-teaching hospitals (56%) and covered by Medicare (84%). Teaching hospitals admitted significantly greater number of patients belonging to the top income quartile and possessing private insurance (p=.000). In-hospital mortality has increased over the 10-year interval analyzed, with a mortality rate of 5.7% in 2005 and 6.1% in 2014. Comparison between teaching and non-teaching hospitals did not show a statistically significant difference in terms of mortality (p=.782). Mean length of stay (LOS) remained relatively constant over the 10-year interval (mean LOS=6.7 days; p=.382), however there was a substantial increase in the hospitalization charges. The overall hospital cost was $29795 in 2004 which increased by over 100% to $59656 in 2014. After adjusting for inflation by CPI healthcare index, the total cost was still higher by 49%. Teaching hospitals had significantly higher charges ($57,592 vs $37,674; p=.000) as well as length of stay (7.28 days vs 5.75 days; p=.000) than non-teaching hospitals. The rates of hospital acquired pneumonia and bacteremia have decreased significantly over the study period (p=.001), whereas rate of Clostridium Difficile (C.Diff) infections increased from 0.42% to 0.67% and UTIs increased from 7.8% to 9.1%. The rate of ICU admissions has also increased from 0.67% in 2005 to 1.51% in 2014 (p=.001). The number of patients receiving in-hospital blood product transfusions has risen significantly from 30,564 in 2005 to 37,360 in 2014 (22.2% rise). Similarly, the number of admissions for major bleeding complications has increased by 34.6% from 1,378 in 2005 to 1,855 in 2014. In comparing the complication rates between the two hospital settings, rates of major bleeding (p =.0002) were lower at academic institutions whereas those of neutropenic fever (p=.0000) were lower at non-teaching hospitals. Differences in the occurrence of pneumonia, sepsis and rate of blood transfusions were not statistically significant between the two. Conclusions: Our study suggests that the overall mortality from MDS has increased over the past decade. Early recognition and diagnosis of MDS can partly explain this finding. However, lack of standard treatment approach for symptomatic MDS patients (with the exception of lenalidomide in 5q deletion), likely contributes to the substantial rise in admissions for transfusions, bleeding complications as well as the death rate. The significant decline in pneumonia and bacteremia could be secondary to increased use of antibiotic prophylaxis whereas use of antibiotics at the same time has probably led to a rise in C.diff infections. Our study also highlights a staggering increase in hospitalization costs. Since MDS is mostly a disease of the elderly, the rate of hospitalizations and the associated financial burden is only expected to rise as the population continues to age. This emphasizes the need for research into disease altering chemotherapy, better outpatient care and transfusion accessibility to prevent hospitalizations. Disclosures Rajeeve: ASH-HONORS Grant: Research Funding.

Introduction: Asparaginase (ASP) has demonstrated a survival benefit in pediatric patients (pts) with acute lymphoblastic leukemia (ALL) and is now part of standard-of-care frontline treatment. As a result, asparaginase preparations have been incorporated into the treatment of adult ALL to improve outcomes. Pegaspargase (PEG-ASP), a modified version of asparaginase with prolonged asparagine depletion, appears to be safe in adults up to age 40 (Stock, et al., Blood, 2019), but is associated with a unique spectrum of toxicities, the risks of which appear to increase with age. Therefore, the safety of PEG-ASP remains a significant concern in older adults w/ ALL. Methods: We conducted a single center retrospective chart review of pts age ≥40 years who received PEG-ASP as part of frontline induction/consolidation or reinduction, between March 2008 and June 2018 at Memorial Sloan Kettering Cancer Center. The primary objective was to evaluate the tolerability and toxicity of PEG-ASP based on the incidence and severity of ASP-related toxicities (hypersensitivity reactions, hypertriglyceridemia, hyperbilirubinemia, transaminitis, pancreatitis, hypofibrinogenemia, etc) according to the Common Terminology Criteria for Adverse Events, version 4.03. Laboratory values recorded were either the peak or the nadir, the more appropriate for toxicity assessment, within a 4-week period following PEG-ASP administration. Secondary objectives were to determine the total number of doses of PEG-ASP administered in comparison to the number of doses intended, and to characterize the rationale for PEG-ASP discontinuation when applicable. Fisher's exact test was used to compare the incidence of PEG-ASP toxicities with respect to pt and treatment characteristics (regimen, age, BMI, gender, Philadelphia chromosome positive (Ph+) vs. Ph-, presence of extramedullary disease, PEG-ASP dose). P values were not adjusted for multiple comparisons. Results: We identified 60 pts with ALL (40 B-ALL and 20 T-ALL) who received at least one dose of PEG-ASP. Nine pts were Ph+. The median pt age at initiation of the treatment was 53, (range, 40 to 80), and 19 pts had a BMI ≥30 kg/m2. Forty-four pts received treatment for newly diagnosed ALL, and 16 pts for relapsed disease. Table 1 lists pt baseline characteristics. Among the 44 pts with newly diagnosed ALL, 27 pts received PEG-ASP as part of pediatric or pediatric-inspired regimens at doses of 2000 - 2500 units/m2, and 1 pt received a modified dose of 1000 units/m2 due to age. The remaining 16 pts received PEG-ASP at doses of 1000 - 2000 units/m2 for consolidation, per established adult regimens (ALL-2 and L-20; Lamanna, et al., Cancer, 2013). Grade 3/4 ASP-related toxicities with a >10% incidence included: hyperbilirubinemia, transaminitis, hypoalbuminemia, hyperglycemia, hypofibrinogenemia, and hypertriglyceridemia. Frontline treatment regimens in which PEG-ASP was used in consolidation cycles only (ALL-2, L-20) were associated w/ a lower incidence of hyperbilirubinemia (p=0.009) and hypertriglyceridemia (p Conclusion: PEG-ASP was incorporated into the treatment of 60 adult ALL pts age ≥40, with manageable toxicity. Seven pts discontinued PEG-ASP due to hypersensitivity reactions and 5 discontinued due to hepatotoxicity, but other reported toxicities did not lead to PEG-ASP discontinuation and the majority of the pts completed all intended doses of PEG-ASP. This study suggests that with careful monitoring, PEG-ASP can safely be administered in adults ≥40 years of age. Disclosures Rajeeve: ASH-HONORS Grant: Research Funding. Tallman:UpToDate: Patents & Royalties; Oncolyze: Consultancy, Membership on an entity's Board of Directors or advisory committees; Delta Fly Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Rigel: Consultancy, Membership on an entity's Board of Directors or advisory committees; Cellerant: Research Funding; Tetraphase: Consultancy, Membership on an entity's Board of Directors or advisory committees; Nohla: Consultancy, Membership on an entity's Board of Directors or advisory committees; BioLineRx: Consultancy, Membership on an entity's Board of Directors or advisory committees; Orsenix: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; ADC Therapeutics: Research Funding; Biosight: Research Funding; Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; KAHR: Consultancy, Membership on an entity's Board of Directors or advisory committees; Daiichi-Sankyo: Consultancy, Membership on an entity's Board of Directors or advisory committees. Geyer:Dava Oncology: Honoraria; Amgen: Research Funding. Park:Takeda: Consultancy; Allogene: Consultancy; Amgen: Consultancy; AstraZeneca: Consultancy; Autolus: Consultancy; GSK: Consultancy; Incyte: Consultancy; Kite Pharma: Consultancy; Novartis: Consultancy.

Background:Significant improvement has been noted in the outcome of patients with advanced hematologic malignancies with the advances in hematopoietic cell transplantation (HCT) techniques. However, it has been observed that patients receiving HCT have increased risk of cardiovascular disease (CVD) over time with increased risk of cardiovascular mortality. Materials and Methods:This was a retrospective observational analysis. We queried the National Inpatient Sample database from 1998 to 2012 for patients aged ≥18 years who had received HCTin the past and were admitted for non-ST-elevation acute coronary syndrome (NSTE-ACS) or ST-elevation myocardial infarction (STEMI). We performed univariate logistic regression followed by multivariate logistic regression analysis to study various demographic factors and comorbiditiesand temporal trends of ACS in these patients. Results:A total of 150,072 patients with prior history of HCT were identified, out of which 952 hospitalizations were for ACS.47.16% of these patients underwent Percutaneous CoronaryIntervention.Mean age for ACS patients was 56.98 years and 71.75% patients were male. The demographic factors found to significantly affect the incidence of ACS were increasing Age (OR 1.02, p=0.01) and Insurance(Medicare as reference)[Medicaid(OR 0.3, p=0.04), private(OR 1.66, p=0.01). Charlson Comorbidity Index (CCI) had significant correlation with incidence of ACS (CCI=1 as reference) [CCI=2(OR 0.12, p=0.00), CCI³3(OR 0.60, p=0.01)]. The Medical comorbidities found to significantly affect the outcome were Congestive Heart Failure (OR 1.53, p=0.04), COPD(OR 0.54, p=0.02), smoking(OR 2.96, p=0.00), underlying CAD (OR 39.65, p=0.00) and Pulmonary Hypertension (OR 4.01, p=0.00). A trend analysis for Incidence of ACS in patients with History of HCT showed overall decline in ACS incidence which was found to be statistically significant. (Trend p-Value 0.003). Conclusion:Our study identifiedvarious factors affecting incidence of ACS in HCT patients. We also discoveredan overall downward trend in incidence of ACSin HCT patients.Further studies need to be conducted to confirm these findings. Disclosures Rajeeve: ASH-HONORS Grant: Research Funding.

Introduction: The presence of underlying cirrhosis poses a serious challenge in treatment of newly diagnosed acute myeloid leukemia (AML) patients. In current practice, patients with significant hyperbilirubinemia are precluded from optimal induction and consolidation therapy. Allogenic stem cell transplant is also not a viable option for these patients. This is the first study aimed at evaluating the safety and trends of utilization of chemotherapy in subset of patients with newly diagnosed AML and comorbid cirrhosis, using the Nationwide Inpatient Sample. Methods: We designed a retrospective study using the Nationwide Inpatient Sample (NIS) data, the largest US inpatient database which includes approximately 76 million patients from 2005 to 2014. The authors identified hospitalizations for induction chemotherapy using the primary discharge diagnosis of 'encounter for chemotherapy' (ICD-9 codes -V58.1, V58.11 and V58.12) or procedure codes for 'administration of antineoplastic agent' (0010, 0015, 9925, 9928) and a secondary diagnosis of acute myeloid leukemia, myeloid sarcoma or acute monocytic leukemia. We excluded patients with relapsed disease or in remission. Amongst this population, patients with a diagnosis of cirrhosis including alcoholic, non-alcoholic and biliary cirrhosis were examined to find the differences in baseline characteristics, annual trends in the number of hospitalizations for chemotherapy and total hospitalization charges. We used logistic regression to calculate the adjusted odds ratios (aOR) for in-hospital mortality among these patients. Results: Between 2005 and 2014, a total of 514,032 admissions were identified with a primary diagnosis of chemotherapy for AML. A total of 1,310 (0.25%) admissions had an underlying diagnosis of cirrhosis. The number of hospitalizations for induction chemotherapy in patients with cirrhosis and AML had a statistically significant increase from 62 in 2005 to 195 in 2014. Interestingly, hospitalization for AML patients without cirrhosis has remained largely constant with 52,673 AML patients admitted in 2005 and 55,925 in 2014 (5.8% increase). In-hospital mortality in patients with cirrhosis and undergoing induction chemotherapy for AML was 14.5% (n=9) in 2005, decreasing to almost half at 7.1% in 2014 (n=14). In-patient mortality for AML patients without cirrhosis undergoing chemotherapy has also decreased, from 4.18% (n=2,205) in 2005 to 3.91% (n=2,190) in 2014. Patients with AML and cirrhosis were less likely to undergo treatment at academic centers (81.8%) than those without cirrhosis (87.1%, p=0.046), and they were less likely to possess private insurance (39.3% vs 33.3%, p=0.000). Mortality rate was higher in patients with AML and cirrhosis (12.2%, n=161) than in those without cirrhosis (4.5%, n=23369). The adjusted odds ratio for mortality in patients with cirrhosis was 2.01 (p=0.001), with older age (p=0.00) and caucasian race (p=0.01) being significant confounders. Average hospital cost for each admission for patients with AML and cirrhosis was ($223,723.6±$16,169), significantly higher than for those without cirrhosis ($129,383). Conclusions: Our study highlights the fact that the management of patients with AML and cirrhosis continues to be a dilemma. With the advances in chemotherapy over the last decade, there has been a positive trend with an increase in the number of hospitalizations for induction chemotherapy in patients with AML and cirrhosis as well as a decrease in mortality. However, the pace of improvement remains slow. Moreover, since cirrhosis is more prevalent in the lower socioeconomic strata, these patients are less likely to have private insurance or receive treatment at an academic center, which may contribute to suboptimal care. The increase in mortality in patients with AML and cirrhosis compared to those without cirrhosis can be explained by a compounding effect of AML on pre-existing complications of cirrhosis, such as coagulopathy, thrombocytopenia, encephalopathy, malnutrition and perturbed drug metabolism. Besides, hepatic dysfunction and hyperbilirubinemia often require chemotherapy dose reduction with preclusion of curative options. Further research is needed to develop standard guidelines and non hepatotoxic chemotherapeutic agents. Disclosures Rajeeve: ASH-HONORS Grant: Research Funding.

Introduction Heparin-induced thrombocytopenia (HIT) is an uncommon and a serious complication of heparin therapy. Currently, only two intravenous Direct Thrombin Inhibitors (DTI) are approved for its therapy. However, their cost and frequent monitoring make the Direct-Acting Oral Anticoagulants (DOACs) an attractive option for its treatment. Several case series and systematic reviews have been published with positive results for use of NOACs in HIT. No head to head trials comparing NOACs and DTI have been published as infrequency of cases make such a study prohibitive. The landmark multicenter trials establishing the role of Argatroban in the treatment of HIT used historical controls to establish it's efficacy. In this study, we aim to compare a cohort of patients treated with Rivaroxaban as recruited from prior case series with a historical cohort treated with Argatroban to establish it's safety and efficacy compared to Argatroban. Methods: A literature review was done using Embase and Pubmed to find HIT patients treated with Rivaroxaban. A total of 14 publications were found including case studies, case series, and systematic reviews. A database was created of a total of 51 HIT patients treated with Rivaroxaban alone or argatroban followed by Rivaroxaban using all the publications. All the cases were confirmed HIT cases based on Serotonin release assay and/or HIT antibody. Platelet nadir and Platelet count at the start of therapy as noted wherever possible. Patients with known bleeding diathesis and bleeding sites were excluded from both the cohorts. Outcomes were thrombosis after initiation of therapy and bleeding after initiation of therapy. The cohort was compared with a historical cohort of patients treated with Argatroban alone in the paper published by Lewis et al. Chi-square test was done to compare new thrombosis and bleeding during hospitalization. Results: No significant difference was found in the rates of new thrombosis (OR: 0.18, CI: 0.02-1.36, p: 0.06). 5% of patients had major bleeding in the argatroban cohort while none of the patients had major bleeding in Rivaroxaban cohort. Conclusion: The study indicates that Argatroban is not significantly better in the treatment of HIT in preventing new thrombosis. However, the bleeding complications might be lower with Rivaroxaban therapy compared to Argatroban therapy. The study is limited by less than ideal comparability of cohorts and low power. However, it provides only such evidence of it's kind. Table. Table. Disclosures No relevant conflicts of interest to declare.

Despite significant progress in the treatment of multiple myeloma (MM), the disease remains incurable. Multiple targeted and biologics-based therapies, including immunomodulatory agent IMiD® compounds (lenalidomide and pomalidomide), proteasome inhibitors (bortezomib and carfilzomib), and monoclonal antibodies (daratumumab and elotuzumab) have shown impressive activity in treating advanced MM. Moreover, triplet regimens combining these agents have consistently proven to be more efficacious than doublets in heavily pretreated patients with limited additional toxic effects. Iberdomide (CC-220) is a novel compound being investigated in a phase I/II study (clinicaltrials.gov NCT02773030) for treatment of lenalidomide- and pomalidomide-relapsed/refractory MM (RRMM) in combination with dexamethasone. Preclinical studies of iberdomide have shown that it more potently binds to cereblon than other cereblon-binding compounds, is more efficient at degrading Aiolos and Ikaros, and has enhanced immunomodulatory activity, inducing greater interleukin-2 secretion and granzyme-b degranulation in immune cells (Matyskiela et al and Bjorklund et al, submitted abstract). Clinical studies of bortezomib and daratumumab in combination with other cereblon-binding agents have demonstrated high tolerability with notable efficacy in the RRMM setting; however, these combinations with iberdomide have not been investigated. Here we show in MM cell lines that iberdomide induces deep Aiolos and Ikaros degradation in the presence of bortezomib at clinically relevant concentrations as determined in healthy volunteers. Furthermore, iberdomide treatment in combination with bortezomib produced synergistic antiproliferative activity and deeper induction of apoptosis than combinations of other clinically approved cereblon-binding compounds with bortezomib across multiple cell lines. In addition, adding dexamethasone resulted in further synergistic antiproliferative activity. In combination with daratumumab, iberdomide also had synergistic anti-MM activity in Complement-Dependent Cytotoxicity (CDC) assays. In co-culture systems using myeloma and immune cells, iberdomide significantly increased the antibody-dependent cellular cytotoxic activity of daratumumab. While iberdomide treatment of MM cell lines resulted in increased CD38 surface expression, combinations were more effective when peripheral blood mononuclear cells (PBMCs) were pretreated, suggesting that iberdomide immunomodulatory activity is a significant contributor to the synergy observed. Interestingly, pretreatment of PBMCs with daratumumab resulted in reduced efficacy of the combination. We observed that the treatment of PBMCs with daratumumab resulted in killing of natural killer (NK) cells in the PBMC culture. In contrast, treatment of PBMCs with iberdomide resulted in proliferation of NK cells, possibly helping to rescue the antagonistic effect of daratumumab on NK cell-mediated antibody‐dependent cellular cytotoxicity. Taken together, these preclinical data support further investigation of iberdomide in combination with both bortezomib/dexamethasone and daratumumab in the clinic. Disclosures Amatangelo: Celgene Corporation: Employment, Equity Ownership. Bjorklund:Celgene Corporation: Employment, Equity Ownership. Kang:Celgene Corporation: Employment, Equity Ownership. Polonskaia:Celgene Corporation: Employment, Equity Ownership. Viswanatha:Celgene Corporation: Employment, Equity Ownership. Thakurta:Celgene Corporation: Employment, Equity Ownership.

Background: We previously reported that the median survival for patients (pts) with relapsed or refractory Hodgkin lymphoma (RRHL) and persistent or recurrent disease following autologous hematopoietic stem cell transplantation (AHCT) was 25 months (Moskowitz, et al. BJH 2009). Since the advent of novel immunotherapeutic and chemotherapeutic agents for RRHL, treatment paradigms have undergone significant transformation. We sought to estimate the survival trends in the modern era for RRHL pts treated with brentuximab vedotin (BV) and/or checkpoint inhibitors (CPIs) for persistent or recurrent disease after AHCT Method: Consecutive pts with RRHL who underwent AHCT from 2008-2015 at Memorial Sloan Kettering Cancer Center (MSKCC) were identified and included if they relapsed or had refractory disease after AHCT, confirmed by biopsy. Overall survival (OS) was estimated from the time of post-ASCT relapse using the Kaplan-Meier method. The significance of potential prognostic factors was assessed using log-rank tests. Results: 186 pts with RRHL underwent AHCT at MSKCC between 2008-2015. 46 pts relapsed or had refractory disease after AHCT, of whom 12 pts were excluded due to incomplete follow-up. Of the remaining 34 pts, there were 19 (55%) males and 15 (44%) females. Median age was 40 years at ASCT (range 21-66 years) and 18 (53%) had primary refractory disease. The median time to relapse after AHCT was 7.3 months (range 2-109 months). Eleven patients (32.3%) received BV as part of their salvage regimen prior to AHCT. Following post-AHCT relapse, 21 (62%) received BV, of whom 13 (38.2%) achieved complete remission (CR), 2 achieved partial remission (PR), and 6 experienced progression of disease (POD). No pts received CPIs before AHCT, and 13 (38.2%) received CPIs following post-AHCT relapse. Responses to CPI included 1 CR and 10 (80%) PRs. Median duration of CPI therapy was 15 months (range, 2-45+ months). With regard to second transplant, 13 (38.2%) pts proceeded to allogeneic hematopoietic stem cell transplantation (alloHCT). Following alloHCT, 7 (53.8%) pts are alive without disease after a median of 4 years follow-up (range, 2-10 years). In addition, 1 pt is alive with active disease, 1 pt died due to POD, and 4 (30%) died from transplant complications. Median OS after post-ASCT relapse was 35.2 months [Figure 1]. As expected, inclusion of either BV or CPI in the post-ASCT salvage regimen resulted in significantly longer survival (2-year OS 82% vs 42%, p Conclusions: Availability of BV and CPIs for RRHL has significantly improved survival for RRHL. Among pts treated with either BV or CPI at post-AHCT relapse, median survival was not reached and 82% of pts are expected to survive at least 2 years after relapse. These data serve to benchmark the expected survival for RRHL pts treated with modern-era therapy. Disclosures Shah: Janssen: Research Funding; Amgen: Research Funding. Moskowitz:Pharmacyclics: Research Funding; Merck & Co: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; Celgene: Consultancy; Seattle Genetics: Consultancy, Research Funding. Moskowitz:ADC Therapeutics: Research Funding; Bristol Myers-Squibb: Consultancy, Research Funding; Merck: Research Funding; Incyte: Research Funding; Takeda: Honoraria; Seattle Genetics: Consultancy, Honoraria, Research Funding.

Background: According to the 2013 HCUP (Health Care Utilization Project) statistical brief, sepsis accounted for US$23.7 billion, or 6.2% of the aggregate costs for all hospitalizations. Sepsis is the second most common cause for hospitalizations, accounting for 3.6% of hospital stays. When considering the sepsis high cost burden, it is of paramount importance to identify the responsible factors. The main objective of this study is to evaluate impact of Non-Hodgkin Lymphoma (NHL) as a comorbidity either a history or as a present diagnosis of NHL, in patients admitted in the hospital with sepsis. Studies suggested increased risk of infections and mortality from bacteremia in patients with NHL in the past, (Shaikh et al, Cancer, 1987; Williams et al, Critical Care 2004 ) but recent data on health care cost burden associated with sepsis in NHL is limited. Methods: We analyzed the admissions for sepsis among adult patients using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, between 2010 and 2014. Patients were stratified into two groups based on the status of NHL (sepsis with NHL and sepsis without NHL) using the ICD-9 CM diagnostic codes. Baseline characteristics including age, race, gender, Charlson comorbidity index, were described in the two groups, using descriptive statistics. A survey weighted multivariate regression analysis was used to adjust for confounders. STATA version 15 (College Station, TX) was used to perform statistical analysis. Results Between 2010 and 2014, a total of 4,501,621 admissions were identified with a primary diagnosis of sepsis. A total of 45,943 admissions had an underlying diagnosis of NHL. Mean age of patients hospitalized with sepsis and with NHL, was higher than patients without NHL (69.04 ±0.167 years; p Conclusion Sepsis is responsible for a major healthcare cost burden in the US. Identification of signs of early sepsis and high-risk patients could support the design of early therapeutic strategies with the goal of decreasing negative outcomes and also decrease overall costs This study highlights NHL as an independent factor for mortality and healthcare costs for sepsis. It may help implement preventive strategies to avoid complications from infections and reduce cost burden associated with sepsis and NHL. Future studies are needed to focus on improving preventive strategies e.g vaccinations, early diagnosis and prompt treatment of infections to prevent progression to sepsis in patients with NHL. Table. Table. Disclosures No relevant conflicts of interest to declare.

Background: Opportunistic infections (OI's) are defined as infections that are more frequent or more severe because of immunosuppression. Conditions like HIV infections, Hematopoietic stem cell transplantation, autoimmune diseases like SLE and RA have been established as risk factors for increased mortality in OI. Studies suggest that lymphomas are a risk factor for mortality associated with OI's like Tuberculosis and candida (Silva et al, 2005; Chen et al, 2014) probably due to underlying immunodeficiency and therapeutic exposures inducing prolonged lymphopenia. Data describing association of underlying Non-Hodgkin Lymphoma (NHL) on mortality associated with OI's is limited. Our objective was to study impact of NHL on in‐hospital mortality of patients hospitalized with OI's. Methods: We analyzed data from the Healthcare Cost and Utilization Project's (HCUP) National Inpatient Sample, between 2010 and 2014 using the ICD-9 codes for Opportunistic infections (OI) which included tuberculosis (010-018), non-tubercular mycobacteria (031), cytomegalovirus (078.5), Herpes Zoster( 053), Candidiasis(112.4), Toxoplasmosis (130), Pneumocystis (136.3), Cryptococcosis(117.5), Listerosis (027.0), Nocardiosis (039), Aspergillosis (117.3) coccidiomycosis (114), histoplasmosis (115), blastomycosis (116.0) . The subset of this cohort with NHL excluding lymphoid leukemias listed as a secondary diagnosis were collected for analysis. Baseline characteristics including age, race, gender, Charlson comorbidity index, and infection with HIV etc. were analyzed for patients with admitted with OI's, with and without underlying diagnosis of NHL. Our primary outcome was in-hospital mortality. Characteristics associated with in‐hospital mortality were identified using multivariable logistic regression. Results Between 2010 and 2014, a total of 1,81,016 admissions were identified with a primary diagnosis of OI. A total of 4442 admissions had an underlying diagnosis of NHL. Mean age of patients hospitalized with OI's with NHL, was higher (65.4 ±0.52 years vs 58.9±0.14years, p Conclusion OI's constitute a major cause of morbidity and mortality in immunocompromised patients. There is limited data from a nationwide analysis which evaluates association of opportunistic infections and lymphoma as an independent marker of mortality. Our study suggests that NHL is an independent risk factor for mortality in patients who were admitted in the hospital for OI's. Further studies should be considered to the role of primary prophylaxis for conditions like PCP to avoid morbidity and mortality associated with these conditions. This will help reduce health care cost burden associated with such hospitalizations. Table. Table. Disclosures No relevant conflicts of interest to declare.

Background: Lympho-proliferative disorders are among the most common neoplasms affecting the ocular adnexa. OALD represents 1% of all lymphomas and 10-15% of extra nodal presentations. The outcomes of local radiation therapy (RT) in MALT vs. non-MALT histology are not known. Herein we present outcomes of local therapy in MALT vs. non-MALT OALD treated at a specialized lymphoma program. Methods: The analysis included 112 consecutive patients (pts) with OALD diagnosed at our institution between 1975- 2014. Patient characteristics, treatment modality and the response to treatment were retrospectively collected. Histology was reviewed by an expert hematopathologist. The primary objective of the study was to assess the failure free survival (FFS) in pts with marginal zone lymphoma of mucosa associated lymphoid tissue (MALT) of ocular adnexa (OA) and non-MALT OA lymphomas treated with local radiation therapy. Complete remission was defined as absence of any disease by imaging. Local failure was defined as any failure within the OA; extra-orbital failure was either regional (within the radiation field) or distant (for cases with limited stage disease at presentation). FFS was defined as time from treatment to any failure (local, regional and distant) and overall survival (OS) as time from treatment to last follow up or death from any cause. FFS and OS were estimated using the Kaplan-Meier methods. Results: Baseline characteristics are shown in Table 1. Of 112, 71(57.7%) of the pts had ocular MALT, and 41(33.3%) had non-MALT (23 follicular, 8 diffuse large cell B cell lymphomas, 3 mantle cell, 6 small lymphocytic lymphoma and 1 T cell lymphoma). Unilateral eye involvement (83.9%) with mass/swelling (55.3%) was the most common presentation. Staging was performed with CT scan and bone marrow biopsy in select cases (n=63, 51%). PET scan was utilized in 33 (29.4%) pts. but was able to upstage in only 5 cases. For ocular MALT, 62(87.3%) received involved field radiation therapy (IFRT), 9(12.6%) chemotherapy. For non-MALT, 34(82.9%) had IFRT, 7(17%) chemotherapy. Among those who received IFRT, 55(75%) in MALT and 21(52%) in non-MALT had limited stage disease (I/II). Among OALD pts treated with only IFRT, 91.7% in ocular MALT and 90.9% in non-MALT achieved complete remission. Resolution of symptoms occurred in 83.3% and 93.3% of ocular MALT and non-MALT respectively. Failure rates of IFRT in ocular MALT vs. non-MALT were as follows: local (7% vs. 12.1%), regional (9.8% vs. 7.3%), and distant (5.6% vs 2.4%). Median follow-up was 3(1-22) years in each group. Median time to failure was 14 years for ocular MALT and 9 years for non-MALT. 3 year and 5 year failure-free survival was 88% and 81% for ocular MALT and 78% and 71% for non-MALT respectively (log rank p=0.26 for FFS) (Fig 1). Conclusions: Both the MALT and non-MALT OALD pts achieved excellent disease control with IFRT with no significant difference in local, regional and distant failure rates. 3 year and 5-year failure free survival were comparable between the two groups. PET scan resulted in upstaging in 5% of pts but did not alter treatment selection, indicating that PET had minimal utility in initial staging of OALD. Table 1. Baseline characteristics TOTAL, N=112 MALT71(63.3%) NON-MALT41(36.6%) Age (median),years 64 (22-84) 66(25-87) Sex, M 25 (35.2%) 16(39%) Race, Caucasian 63 (88%) 34(83%) Symptoms at presentation - Mass/Swelling - Visual changes - Other 35 (49.2%) 11 (15.4%) 2 (2.8%) 27(66%) 11(27%) 1(2.4%) Site of origin - Orbital - Conjunctival - Lacrimal gland - Eyelid - Other 31 (43.6%) 26 (36.6%) 10 (14%) 1 (1.4%) 4 (5.6%) 14(34.1%) 14(34.1%) 10(24.3%) 3(7.3%) 0 Unilateral Involvement 60 (86%) 34(83%) Stage at presentation - I - II - III - IV - Unknown 60 (85%) 0 1 (1.4%) 8 (11.2%) 2(2.8%) 24(59%) 4(9.7%) 2(4.8%) 7(17%) 4(9.7%) Figure 1. Failure free surivival MALT(marginal zone) vs. non-MALT(other) with IFRT Figure 1. Failure free surivival MALT(marginal zone) vs. non-MALT(other) with IFRT Disclosures Hari: BMS: Consultancy; Janssen: Consultancy; Novartis: Consultancy; Celgene: Consultancy; Takeda: Consultancy; Sanofi: Consultancy; Spectrum: Consultancy. Fenske:Millennium/Takeda: Research Funding; Seattle Genetics: Honoraria; Pharmacyclics: Honoraria; Celgene: Honoraria.

Abstract 4061 Background: High-dose chemotherapy and/or radiotherapy are effective treatment strategies for patients with life-threatening hematologic malignancies. A critical step to the success of transplantation is achieving adequate mobilization of CD34+ stem cells from the bone marrow into the peripheral blood to provide sufficient cell yield after apheresis for the transplant. Plerixafor combined with granulocyte colony-stimulating factor (G-CSF) has proven efficacious in mobilizing CD34+ stem cells in patients with lymphoma and myeloma prior to autologous stem cell transplantation. In the phase 3 clinical trials of plerixafor plus G-CSF for SCM, plerixafor was administered at 10:00 pm on days prior to apheresis. This dosing schedule is based on the peak level of CD34+ cells in the peripheral blood (PB) at 11–14 hours after administration; however PB CD34+ cell levels were elevated from 4–18 hours after plerixafor administration. Due to inconvenience in dosing plerixafor at 10:00pm, we took advantage of its pharmacodynamic profile and explored an alternative dosing schedule, giving plerixafor at 5:00 pm. Here, we report our updated experience with the efficacy of this schedule. Method: We performed a retrospective study using our Stem Cell Harvest database. A total of 58 patients (31 lymphoma, 27 myeloma) underwent mobilization with G-CSF + plerixafor, either as front-line (n=51) or as salvage (n=7) mobilization strategies between February 2009 through May 2010. Mobilization consisted of G-CSF 10 μg/kg SC administered daily at 6:00 am day 1 through 4 plus plerixafor 0.24 mg/kg SC given once daily at 5:00 pm in an outpatient clinic beginning on day 4. For patients with renal impairment (ie, creatinine clearance ≤50 mL/min), the dose of plerixafor was lowered by a third to 0.16 mg/kg. Daily apheresis began at 8:30 am on the morning of day 5 and continued for up to 4 days, with a minimum collection goal defined as ≥ 2 × 106 CD34+ cells/kg for lymphoma patients and ≥ 4 × 106 CD34+ cells/kg for myeloma patients. Mobilization with G-CSF plus plerixafor and apheresis were halted once the minimum goal was reached between day 2 and 4 of apheresis, or after a single collection achieved the optimal goal which was defined as ≥ 4 × 106 (lymphoma) or ≥ 8 × 106 (myeloma) CD34+ cells/kg. The mobilization strategy was considered a failure if patients did not reach the minimum CD34+ cell collection goal within the 4 days of apheresis. Results: G-CSF + plerixafor mobilization yielded a median 5.13 × 106 CD34+ cells/kg (range, 0.06–25.8) in a median of 2 apheresis days. Forty-five of 58 (78%) patients achieved the minimum CD34+ cells/kg required for transplantation, including 30 (52%) patients who achieved this goal on the first day of apheresis. Overall, 52 (90%) patients proceeded to transplantation, with median neutrophil and platelet engraftment times of 11 and 18 days, respectively. Conclusion: In summary, the alternative 5:00 pm dosing of plerixafor for stem cell mobilization provided a more convenient dosing schedule while ensuring that a majority of lymphoma and myeloma patients achieved the minimum CD34+ cell yield required to proceed to transplantation. Disclosures: Tornatta: Genzyme: Consultancy, Honoraria, Speakers Bureau. Fung:Genzyme: Consultancy, Honoraria, Speakers Bureau.